Urinary nitrite excretion and urinary variables in patients with primary nocturnal frequency of micturition: effects of indomethacin suppositories

Management of severe polyuria in idiopathic Fanconi syndrome

BACKGROUND

Polyuria is a common problem in patients with tubular diseases, especially for those with CKD and high-output Fanconi syndrome. There are currently no guidelines on how to treat debilitating polyuria, in children or adults, and vasopressin is usually not effective.

CASE-DIAGNOSIS/TREATMENT

A 13-year-old female with idiopathic Fanconi syndrome and an eGFR of 69 mL/min/1.73 m² was severely affected by polyuria of 5 L per day (voiding at least 11 times during the day and up to 8 times at night), impacting her mood (measured by the RCADS-child) and academic performance at school. In the absence of guidelines and with literature discouraging the use of indomethacin in this condition, we attempted indomethacin treatment at a dose of 2 mg/kg divided in two doses with substantial success. Urine output dropped to 2.5L and this was accompanied by a substantial decrease of her sodium wasting from 24.6 to 7.7 mmol/kg/day. Over the course of 18 months, the patient's eGFR dropped temporarily to 60 mL/min/1.73 m² and was 68 mL/min/1.73 m² at last follow-up. However, a sodium-23 (²³Na) MRI of her thigh revealed ongoing moderate sodium decrease in her skin and substantial Na⁺ decrease in her muscle when compared to age-matched peers with normal kidney function.

CONCLUSIONS

Indomethacin may be a safe and effective treatment option for polyuria in idiopathic Fanconi syndrome.

Effects of Honey on the Urinary Total Nitrite and Prostaglandins Concentration

OBJECTIVES

To evaluate effects of natural and artificial honey solutions on urinary nitrite content, prostaglandin excretion and urinary variables in healthy individuals.

METHODS

The study comprised 12 individuals, nine males and three females; age range 25-45 years. Urinary total nitrite, prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha) and thromboxane B2 (TXB2) were assessed in spot morning sample and 1, 2, and 3 hours after ingestion of 80 g of natural honey dissolved in 250 ml water. Honey solution was given at night; urine volume, urinary osmolality and electrolytes, and serum osmolality and electrolytes, were assayed 10 hours after drinking honey. Same procedure was repeated after drinking artificial honey (30 g glucose plus 38 g fructose) and compared with control (drinking 250 ml of water).

RESULTS

The mean (SD) of total urinary nitrite excretion was 103 +/- 43.5 micromol/l which was increased by 40%, 55% and 74% at 1, 2, and 3 hours after drinking honey solution respectively. The mean urinary PGE2 was 1.323 +/- 0.8 ng/ml that was decreased by 31% 3 hours after honey ingestion. The mean urinary PGF2 alpha was 1.554 +/- 1.2 ng/ml and that of TXB2 was 0.35 +/- 0.4 ng/ml. Forty-four percent reductions in urinary PGF2 alpha and 67% reduction in TXB2 were obtained 3 hours after drinking honey. Honey increased insignificantly free water clearance, filtered sodium and creatinine clearance. It decreased insignificantly urinary osmolality, urinary calcium, urinary sodium, and fasting blood sugar (FBS). Little changes were obtained in urine volume and urinary urea, glucose and creatinine concentration. Artificial honey decreased urinary nitrite and increased urinary prostaglandins concentration. It increased insignificantly free water clearance, filtered sodium, urinary urea, urinary creatinine and creatinine clearance. It decreased insignificantly urinary osmolality, urinary calcium, urinary sodium, and fractional excretion of sodium (FENa). Artificial honey increased FBS by 14% and urinary glucose by 76.5%, and decreased serum sodium and plasma osmolality.

CONCLUSION

Honey solution decreased urinary prostaglandins concentration and increased total urinary nitrite content whilst artificial honey decreased urinary nitrite and increased urinary prostaglandins.